Melotti Rita Maria, Negro Antonella, Amenta Enrico, Taffurelli Mario, Credico Carmen, Grilli Roberto
Dipartimento di scienze chirurgiche e anestesiologiche, Università degli studi di Bologna.
Epidemiol Prev. 2006 May-Jun;30(3):153-60.
To explore determinants of clinical priority and of actual waiting times for elective surgical interventions. DESIGN, SETTING PARTECIPANTS: 405 patients cared for at two general surgery wards, receiving an explicit judgement of clinical priority and whose actual waiting times to surgery were assessed. Clinicalpriority was assessed through 0 (no priority) to 10 (maximum priority).
Identification through multivariate regression techniques of the clinical characteristics associated with high clinical priority (score 28) and with shorter actual waiting times.
Patients with cancer, severe pain, relevant impairment in functional status and relevant expert improvement on quality and duration of survival were more frequently attributed a high clinical priority. As for waiting times, presence of cancer was the only factor associated with shorter waitings. Only for cancer patients high priority judgement was associated with shorter waiting times (median 21 vs. 69 days; p < 0.008).
These findings suggest that actual waiting times are not influenced by the same clinical characteristics that clinicians value when assigning clinical priority. That may have some relevant implications on how waiting lists are managed, if consideration of relevant aspects of patients' needs are missed.
探讨择期手术干预的临床优先级及实际等待时间的决定因素。
设计、地点、参与者：405例在两个普通外科病房接受治疗的患者，接受了临床优先级的明确判定，并对其手术实际等待时间进行了评估。临床优先级通过0（无优先级）至10（最高优先级）进行评估。
通过多变量回归技术确定与高临床优先级（评分≥8）及较短实际等待时间相关的临床特征。
患有癌症、剧痛、功能状态有相关损害以及在生存质量和生存期方面有相关专家改善的患者更常被赋予高临床优先级。至于等待时间，癌症的存在是与较短等待时间相关的唯一因素。仅对于癌症患者，高优先级判定与较短等待时间相关（中位数21天对69天；p<0.008）。
这些发现表明，实际等待时间不受临床医生在确定临床优先级时所重视的相同临床特征的影响。如果忽略了患者需求的相关方面，这可能对候诊名单的管理产生一些相关影响。
